Browse > Article
http://dx.doi.org/10.3348/kjr.2013.14.2.375

Imaging Characteristics of Stage I Non-Small Cell Lung Cancer on CT and FDG-PET: Relationship with Epidermal Growth Factor Receptor Protein Expression Status and Survival  

Lee, Youkyung (Department of Radiology, Seoul National University Hospital)
Lee, Hyun-Ju (Department of Radiology, Seoul National University Hospital)
Kim, Young Tae (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Xenotransplantation Research Center, Clinical Research Center, Seoul National University College of Medicine)
Kang, Chang Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Xenotransplantation Research Center, Clinical Research Center, Seoul National University College of Medicine)
Goo, Jin Mo (Department of Radiology, Seoul National University Hospital)
Park, Chang Min (Department of Radiology, Seoul National University Hospital)
Paeng, Jin Chul (Department of Nuclear Medicine, Seoul National University Hospital)
Chung, Doo Hyun (Department of Pathology, Seoul National University Hospital)
Jeon, Yoon Kyung (Department of Pathology, Seoul National University Hospital)
Publication Information
Korean Journal of Radiology / v.14, no.2, 2013 , pp. 375-383 More about this Journal
Abstract
Objective: To identify CT and FDG-PET features associated with epidermal growth factor receptor (EGFR) protein overexpression, and to evaluate whether imaging features and EGFR-overexpression can help predict clinical outcome. Materials and Methods: In 214 patients (M : F = 129 : 85; mean age, 63.2) who underwent curative resection of stage I non-small cell lung cancer, EGFR protein expression status was determined through immunohistochemical analysis. Imaging characteristics on CT and FDG-PET was assessed in relation to EGFR-overexpression. Imaging features and EGFR-overexpression were also evaluated for clinical outcome by using the Cox proportional hazards model. Results: EGFR-overexpression was found in 51 patients (23.8%). It was significantly more frequent in tumors with an $SUV_{max}$ > 5.0 (p < 0.0001), diameter > 2.43 cm (p < 0.0001), and with ground glass opacity ${\leq}$ 50% (p = 0.0073). $SUV_{max}$ > 5.0 (OR, 3.113; 95% CI, 1.375-7.049; p = 0.006) and diameter > 2.43 cm (OR, 2.799; 95% CI, 1.285-6.095; p = 0.010) were independent predictors of EGFR overexpression. Multivariate analysis showed that $SUV_{max}$ > 4.0 (hazard ratio, 10.660; 95% CI, 1.370-82.966; p = 0.024), and the presence of cavitation within a tumor (hazard ratio, 3.122; 95% CI, 1.143-8.532; p = 0.026) were factors associated with poor prognosis. Conclusion: EGFR-overexpression is associated with high $SUV_{max}$, large tumor diameter, and small GGO proportion. CT and FDG-PET findings, which are closely related to EGFR overexpression, can be valuable in the prediction of clinical outcome.
Keywords
EGFR; EGFR protein; CT; FDG-PET; Non-small cell lung cancer;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Onn, A, Correa, AM, Gilcrease, M, Isobe, T, Massarelli, E, Bucana, CD,Synchronous overexpression of epidermal growth factor receptor and HER2-neu protein is a predictor of poor outcome in patients with stage I non-small cell lung cancer, Clin Cancer Res, 10, 25, 136-143(2004)   DOI
2 Franklin, WA, Veve, R, Hirsch, FR, Helfrich, BA, Bunn, PA,Epidermal growth factor receptor family in lung cancer and premalignancy, Semin Oncol, 29, 26, 3-14(2002)   DOI
3 Suzuki, K, Kusumoto, M, Watanabe, S, Tsuchiya, R, Asamura, H,Radiologic classification of small adenocarcinoma of the lung: radiologic-pathologic correlation and its prognostic impact, Ann Thorac Surg, 81, 27, 413-419(2006)   DOI
4 Takashima, S, Maruyama, Y, Hasegawa, M, Yamanda, T, Honda, T, Kadoya, M,Prognostic significance of high-resolution CT findings in small peripheral adenocarcinoma of the lung: a retrospective study on 64 patients, Lung Cancer, 36, 28, 289-295(2002)   DOI
5 Vazquez, M, Carter, D, Brambilla, E, Gazdar, A, Noguchi, M, Travis, WD,Solitary and multiple resected adenocarcinomas after CT screening for lung cancer: histopathologic features and their prognostic implications, Lung Cancer, 64, 29, 148-154(2009)   DOI
6 Chaudhuri, MR,Primary pulmonary cavitating carcinomas, Thorax, 28, 30, 354-366(1973)   DOI
7 Berger, M, Thompson, JR,Cavitary carcinomatosis of the lungs. Report of a case, Dis Chest, 52, 31, 106-111(1967)   DOI
8 Kolodziejski, LS, Dyczek, S, Duda, K, Goralczyk, J, Wysocki, WM, Lobaziewicz, W,Cavitated tumor as a clinical subentity in squamous cell lung cancer patients, Neoplasma, 50, 32, 66-73(2003)
9 Pentheroudakis, G, Kostadima, L, Fountzilas, G, Kalogera-Fountzila, A, Klouvas, G, Kalofonos, C,Cavitating squamous cell lung carcinoma-distinct entity or not? Analysis of radiologic, histologic, and clinical features, Lung Cancer, 45, 33, 349-355(2004)   DOI
10 Sasaki, R, Komaki, R, Macapinlac, H, Erasmus, J, Allen, P, Forster, K,[18F]fluorodeoxyglucose uptake by positron emission tomography predicts outcome of non-small-cell lung cancer, J Clin Oncol, 23, 19, 1136-1143(2005)   DOI
11 Shin, KM, Lee, KS, Shim, YM, Kim, J, Kim, BT, Kwon, OJ,FDG PET/CT and mediastinal nodal metastasis detection in stage T1 non-small cell lung cancer: prognostic implications, Korean J Radiol, 9, 20, 481-489(2008)   DOI
12 Taylor, MD, Smith, PW, Brix, WK, Wick, MR, Theodosakis, N, Swenson, BR,Fluorodeoxyglucose positron emission tomography and tumor marker expression in non-small cell lung cancer, J Thorac Cardiovasc Surg, 137, 21, 43-48(2009)   DOI
13 Giroux, DJ, Rami-Porta, R, Chansky, K, Crowley, JJ, Groome, PA, Postmus, PE,The IASLC Lung Cancer Staging Project: data elements for the prospective project, J Thorac Oncol, 4, 22, 679-683(2009)   DOI
14 Yano, M, Sasaki, H, Kobayashi, Y, Yukiue, H, Haneda, H, Suzuki, E,Epidermal growth factor receptor gene mutation and computed tomographic findings in peripheral pulmonary adenocarcinoma, J Thorac Oncol, 1, 23, 413-416(2006)   DOI
15 Onn, A, Choe, DH, Herbst, RS, Correa, AM, Munden, RF, Truong, MT,Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome, Radiology, 237, 24, 342-347(2005)   DOI
16 Lee, HJ, Goo, JM, Lee, CH, Park, CM, Kim, KG, Park, EA,Predictive CT findings of malignancy in ground-glass nodules on thin-section chest CT: the effects on radiologist performance, Eur Radiol, 19, 11, 552-560(2009)   DOI
17 Lee, KW, Im, JG, Kim, TJ, Dae, CM,A new method of measuring the amount of soft tissue in pulmonary ground-glass opacity nodules: a phantom study, Korean J Radiol, 9, 17, 219-225(2008)   DOI
18 van Klaveren, RJ, Oudkerk, M, Prokop, M, Scholten, ET, Nackaerts, K, Vernhout, R,Management of lung nodules detected by volume CT scanning, N Engl J Med, 361, 18, 2221-2229(2009)   DOI
19 Travis, WD, Brambilla, E, Noguchi, M, Nicholson, AG, Geisinger, KR, Yatabe, Y,International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma, J Thorac Oncol, 6, 10, 244-285(2011)   DOI
20 Park, EA, Lee, HJ, Kim, YT, Kang, CH, Kang, KW, Jeon, YK,EGFR gene copy number in adenocarcinoma of the lung by FISH analysis: investigation of significantly related factors on CT, FDG-PET, and histopathology, Lung Cancer, 64, 12, 179-186(2009)   DOI
21 Jeon, YK, Sung, SW, Chung, JH, Park, WS, Seo, JW, Kim, CW,Clinicopathologic features and prognostic implications of epidermal growth factor receptor (EGFR) gene copy number and protein expression in non-small cell lung cancer, Lung Cancer, 54, 13, 387-398(2006)   DOI
22 Rami-Porta, R, Ball, D, Crowley, J, Giroux, DJ, Jett, J, Travis, WD,The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer, J Thorac Oncol, 2, 14, 593-602(2007)   DOI
23 Groome, PA, Bolejack, V, Crowley, JJ, Kennedy, C, Krasnik, M, Sobin, LH,The IASLC Lung Cancer Staging Project: validation of the proposals for revision of the T, N, and M descriptors and consequent stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours, J Thorac Oncol, 2, 15, 694-705(2007)   DOI
24 Yano, T, Morodomi, Y, Ito, K, Yoshida, T, Haro, A, Shoji, F,Verification of the newly proposed T category (seventh edition of the tumor, node, and metastasis classification) from a clinicopathological viewpoint in non-small cell lung cancer-special reference to tumor size, J Thorac Oncol, 5, 16, 45-48(2010)   DOI
25 Ohsaki, Y, Tanno, S, Fujita, Y, Toyoshima, E, Fujiuchi, S, Nishigaki, Y,Epidermal growth factor receptor expression correlates with poor prognosis in non-small cell lung cancer patients with p53 overexpression, Oncol Rep, 7, 5, 603-607(2000)
26 Cappuzzo, F, Gregorc, V, Rossi, E, Cancellieri, A, Magrini, E, Paties, CT,Gefitinib in pretreated non-small-cell lung cancer (NSCLC): analysis of efficacy and correlation with HER2 and epidermal growth factor receptor expression in locally advanced or metastatic NSCLC, J Clin Oncol, 21, 2, 2658-2663(2003)   DOI
27 Huang, SM, Harari, PM,Epidermal growth factor receptor inhibition in cancer therapy: biology, rationale and preliminary clinical results, Invest New Drugs, 17, 3, 259-269(1999)   DOI
28 Nicholson, RI, Gee, JM, Harper, ME,EGFR and cancer prognosis, Eur J Cancer, 37, 4, S9-S15(2001)
29 Volm, M, Rittgen, W, Drings, P,Prognostic value of ERBB-1, VEGF, cyclin A, FOS, JUN and MYC in patients with squamous cell lung carcinomas, Br J Cancer, 77, 6, 663-669(1998)   DOI
30 Goldstraw, P, Crowley, J, Chansky, K, Giroux, DJ, Groome, PA, Rami-Porta, R,The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours, J Thorac Oncol, 2, 7, 706-714(2007)   DOI
31 Rusch, VW, Crowley, J, Giroux, DJ, Goldstraw, P, Im, JG, Tsuboi, M,The IASLC Lung Cancer Staging Project: proposals for the revision of the N descriptors in the forthcoming seventh edition of the TNM classification for lung cancer, J Thorac Oncol, 2, 8, 603-612(2007)   DOI
32 Postmus, PE, Brambilla, E, Chansky, K, Crowley, J, Goldstraw, P, Patz, EF,The IASLC Lung Cancer Staging Project: proposals for revision of the M descriptors in the forthcoming (seventh) edition of the TNM classification of lung cancer, J Thorac Oncol, 2, 9, 686-693(2007)   DOI
33 Schiller, JH, Harrington, D, Belani, CP, Langer, C, Sandler, A, Krook, J,Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer, N Engl J Med, 346, 1, 92-98(2002)   DOI